The Voice of Nursing
Northwest Ambulatory Care Nursing
November 20, 2014
Community of Practice Forums (CoP) Forums
Patricia Rojas, Director, Ambulatory Nursing and Optimization
Chris Sawyer, Professional Development Consultant, Onboarding, Ambulatory Nursing and Optimization
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KPNW Ambulatory Care Voice of Nursing, April 2014
Nurse Leaders from Across Ambulatory Care
Beth Christensen, Senior Administrator, Specialty Care
Nancy Turner, Dept. Administrator, Specialty Care
Ebony Sage, Asst. Dept. Administrator, Specialty Care
Janie Lewis, Dept. Administrator, Specialty Care
Kelly Bice, Dept. Administrator, Specialty Care
Martina Fetter, Senior Administrator, Primary Care
Mynell Harper, Dept. Administrator, Primary Care
Dana Nguyen, Dept. Administrator, Primary Care
Dennis Rouse, Dept. Administrator, Primary Care
Jan Weaver-Shelby, Dept. Administrator, Primary Care
Kara Wills, Dept. Administrator, Primary Care
Ann Casterlin, Director, Continuing Care Services (CCS)
Anna Scott, Manager, Palliative Care, CCS
Anne Mooney, Clinical Supervisor, Home Infusion, CCS
Susan Chauvie, Manager, Geriatrics/LongTerm Care, CCS
Susan Mulligan, Prog. Dir., Hospice/Palliative Care, CCS
Suzanne Symons, Care Coordination, CCS
Kris Anderson, Mgr, Clinical Quality Support Services (CQSS)
Nancy Craig, Clinical Quality Support Services (CQSS)
Judy Lewis, Clinical Quality Support Services (CQSS)
Barbara Kyler, Mgr, Regional Quality Resource Management
Twila Cain Pierce, RN, Medicaid and Charitable Programs
Lynn Barker, Director, Medicaid and Charitable Programs
Natasha McLeron, RN Mgr, Regional Call Center / Advice
David Henrichsen, OFNHP Primary Care Labor Partner
Toren Brolutti, OFNHP Specialty Care Labor Partner
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Nurse Leaders from Ambulatory
Nursing and Optimization
Trish Rojas, Director
Lori Hill, Dir of Professional Development
Jennifer Houten, Dir of Professional Practice
Anja Peersen, Dir of Quality Systems &
Sustainability
Meagan Mangus, Informatics Manager
RN Professional Development Consultants:
Chris Sawyer
Elizabeth Cronk
Mary Johnson
Heather Fisher
Katie Johansen
Ansley Beshere
Sandy Heresa
Lisa Alvarado
KPNW Ambulatory Nursing
Aligned with KP Nursing Vision
Kaiser Permanente Nurses
advance the art and science
of nursing in a patientcentered healing
environment through our
professional practice and
leadership.
Extraordinary nursing care.
Every patient. Every time.
Mission:
The purpose of the KPNW Ambulatory Nursing Leadership Council is to unite and align our 1,100 plus
nurses under a single vision, set of values and nursing model across all ambulatory care sites and, through
collaboration with our Hospital nursing colleagues across the full continuum of care. Kaiser Permanente
Northwest members will know they were being cared for by a Kaiser Permanente nurse, regardless of
where they entered the system. The Ambulatory Nursing Leadership Council will lead standardization of
nursing where there is evidence, and elevate nursing to accomplish KPNW strategic goals.
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KPNW Ambulatory Nursing
Voice of Nursing Action Plan Objectives
.
INSPIRE ambulatory care
Establish nursing leadership
INFRASTRUCTURE to
develop and deliver high
quality, affordable, health
care services to improve the
health of our members and
community
nurses at all levels to
advance the art and science
of nursing in a patientcentered healing
environment through our
professional practice and
leadership.
Implement EDUCATION to
advance to top-of-scope
nursing practice and
competency and ensure
quality of patient outcomes.
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Adopt EVALUATION
metrics to ensure nursing
practice is improving health
outcomes
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Inspiration
Embedding KP Nursing Vision, Values and
Professional Practice throughout Ambulatory Nursing
Onboarding for all ambulatory care nursing.
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Developed KPNW Ambulatory Nursing Orientation
Collaboration in Action
Regional nursing recognition program
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Increased March of Dimes nominations; 4 KPNW winners
Implemented Daisy Award for KPNW Ambulatory Care
Pinning Program Implementation in process
Regional RNTL orientation
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Revised and aligned with KPNW Ambulatory Nursing
Orientation; Roll-out in January 2015
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Infrastructure
Leadership Collaboration Across the Continuum
Northwest Nursing Leadership Council
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Nursing Leaders from Ambulatory Nursing, Continuing Care Services, Kaiser
Westside Medical Center and Kaiser Sunnyside Medical Center.
Shared progress on vision and professional practice in nursing
Shared planning to view nursing across all care transitions
Opportunity to present nursing vision and strategies to senior leadership team
Shared concerns about RN Recruiting (first step to improved hiring and
workforce planning)
Ambulatory Nursing Leadership Council

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Leveraged Voice of Nursing, first action item from VON was to form ANLC
Expanding in December to include all frontline RN Managers
Professional Development Collaborative
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Formed July 2014: All Ambulatory and Inpatient Nursing Professional Development
Consultants
Nursing orientation across the continuum
New product implementation
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Education
Preparing Nurses for Current and Future Roles
Onboarding RN Team Leads with their Manager
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Promotes collaboration and top of scope nursing practice
Ensures support and relationships needed for nursing
leadership
Pilot completed November 6
Care Coordination Curriculum
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Rapid implementation of care coordination roles in KPNW
Patient-Family Centered Care is core
Renewing skills not required in recent years
Implementing Strategies to Advance Nursing Education
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BSN Program support initiated
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Evaluation
Discussion underway for future dashboard
Reviewing available data to demonstrate nursing role

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Process measures as preliminary indicators of RNTL impact
on care delivery results: % of nurses showing “independent” in
skills assessed via the Member Interaction Assessment after
their 4th month of coaching”
Working with analytics to measure impact of implementing
nurse visits and advance nursing procedures: number of RN
Visits instead of Physician Visits.
Future opportunities

Develop nursing sensitive outcome metrics
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What We Have Learned
Leadership Development at the Speed of Change
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Forming Ambulatory Nursing Leadership Council: commitment
and lots to do
Ambulatory Nursing Leaders collaborated to lead Ebola
Preparedness
Next: RN Leadership Roles part of 2015 Strategy
Next: Recruiting, Workforce and Leadership Development
Time to Spread Inspiration and Engagement
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Progress: bookmarks, elevator speeches, newsletter
information, practice model, community events, onboarding
Next: Expand ANLC to include all RN Managers
Next: Planning for RN Summit
Next: Engage in community nursing organizations
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Voice of Nursing In Action:
KPNW Ambulatory Nursing
Regional Orientation
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Orientation Structure
Department
Regional
“Time spent with a
preceptor, mentor,
buddy to learn the
specifics of the job” and
a “period of working
independently, but being
closely supervised”.
Orientation “to
organizational systems,
mission, polices, etc.”
Wright, D. 2005. The ultimate guide to competency assessment in health care. p 18.
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Current State Gaps
Audience
• Only Back Office RN, LPN and MA
Content
• “Skill” focused
• Lack of interpersonal and cognitive content
• Redundancies
Timing
• Too late in orientation (up to 6 weeks)
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Future State Solutions
Audience
• All Ambulatory RN, LPN, MA
Content
• KP Integrated Health Care Model
• Service
• Spiral back to and build on important concepts
• RN and LPN- KP Nursing PPM and Nursing Process
Timing
• 1st class in 1st week of employment
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Ambulatory Nursing and Optimization
Orientation (ANOO)
New Class offered weekly
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Focus on clinical culture and practice standards common to
ambulatory patient care staff
Content Overview
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Welcome to KPNW- You’re a part of something big!
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How we provide outstanding service
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How we all work together to provide extraordinary care
Intro to the KP Nursing PPM, focusing on Patient and Family
Centered Care
Service and Care Experience
Cross-Cultural Health Care
Communication and Documentation best practices
Orientation to orientation
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KP Learn, KP HealthStream
Overview of the orientation process
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Foundations Classes: Nurse and MA
Revised Classes offered every other week
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Focus on role specific expectations, skills and resources
Nurse Foundations
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KP Nursing Professional Practice Model (Module 1 and 2)
Application of the Nursing Process to Ambulatory Care
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ANA Scope and Standards, OR/WA State Practice Acts, KPNW
Policies and Procedures
MA Foundations
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Visit Management
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January ‘15 Go-Live
3rd week +
2nd-3rd
1st
week
week
Other assignment
specific ILTs and WBTs
Nurse
Foundations
MA
Foundations
Ambulatory Nursing and
Optimization Orientation (ANOO)
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What We Have Learned….
Strategy: Slow and Steady
• Principles of Implementation:
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Must speak to nurses – support for their passion for nursing
Keep the dialogue open and the conversation interactive
Nurses need to feel empowered to affect change in their practice
“The key to successful implementation in our facility has
been, and continues to be, early engagement of respected,
formal and informal nursing leaders.”
– Adrienne Enghouse
Labor Partner
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What We Need Help With…
• Challenges:
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Time of uncertainty for both labor and management
Initiative fatigue
• Questions/Requests for Assistance:
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Has anyone begun to embed PPM into job descriptions?
How do we continue to provide inspiration for this work?
Looking for creative ideas…
Evaluation: Are we measuring correct outcomes to determine
efficacy of the PPM?
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Q&A
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